1. Field of the Invention
The present invention relates to pharmaceutical compositions, and in particular to pharmaceutical compositions containing an aldose reductase inhibitor (ARI) and an angiotensin converting enzyme (ACE) inhibitor, is useful in the prevention and treatment of the complications of diabetes mellitus. In particular, the invention relates to combinations of an ACE with substituted indole acetic acids.
2. Description of the Related Art
The use of aldose reductase inhibitors (ARIs) for the treatment of diabetic complications is well known. The complications arise from elevated levels of glucose in tissues such as the nerve, kidney, retina and lens that enters the polyol pathway and is converted to sorbitol via aldose reductase. Because sorbitol does not easily cross cell membranes, it accumulates inside certain cells resulting in changes in osmotic pressure, alterations in the redox state of pyridine nucleotides (i.e. increased NADH/AND+ ratio) and depleted intracellular levels of myoinositol. These biochemical changes, which have been linked to diabetic complications, can be controlled by inhibitors of aldose reductase.
The use of aldose reductase inhibitors for the treatment of diabetic complications has been extensively reviewed, see: (a) Textbook of Diabetes, 2nd ed.; Pickup, J. C. and Williams, G. (Eds.); Blackwell Science, Boston, Mass. 1997.; (b) Larson, E. R.; Lipinski, C. A. and Sarges, R., Medicinal Research Reviews, 1988, 8 (2), 159-198; (c) Dvornik, D. Aldose Reductase Inhibition. Porte, D. (ed), Biomedical Information Corp., New York, N.Y. Mc Graw Hill 1987; (d) Petrash, J. M., Tarle, I., Wilson, D. K. Quiocho. F. A. Perspectives in Diabetes, Aldose Reductase Catalysis and Crystalography: Insights From Recent Advances in Enzyme Structure and Function, Diabetes, 1994, 43, 955; (e) Aotsuka, T.; Abe, N.; Fukushima, K.; Ashizawa, N. and Yoshida, M., Bioorg. and Med. Chem. Letters, 1997, 7, 1677, (f), T., Nagaki, Y.; Ishii, A.; Konishi, Y.; Yago, H; Seishi, S.; Okukado, N.; Okamoto, K., J. Med. Chem., 1997, 40, 684; (g) Ashizawa, N.; Yoshida, M.; Sugiyama, Y.; Akaike, N.; Ohbayashi, S.; Aotsuka, T.; Abe, N.; Fukushima, K.; Matsuura, A, Jpn. J. Pharmacol. 1997, 73, 133; (h) Kador, P. F.; Sharpless, N. E., Molecular Pharmacology, 1983, 24, 521; (I) Kador, P. F.; Kinoshita, J. H.; Sharpless, N. E., J. Med. Chem. 1985, 28 (7), 841; (j) Hotta, N., Biomed. and Pharmacother. 1995, 5, 232; (k) Mylar, B.; Larson, E. R.; Beyer, T. A.; Zembrowski, W. J.; Aldinger, C. E.; Dee, F. D.; Siegel, T. W.; Singleton, D. H., J. Med. Chem. 1991, 34, 108; (l) Dvornik, D. Croatica Chemica Acta 1996, 69 (2), 613.
Although many aldose reductase inhibitors have been extensively developed, none have demonstrated sufficient efficacy in human clinical trials without significant undesirable side effects. Thus no aldose reductase inhibitors are currently available as approved therapeutic agents in the United States; and consequently, there is still a significant need for new, efficacious and safe medications for the treatment of diabetic complications.
Treatment to normalize the plasma glucose concentration in people afflicted with type 2 diabetes currently includes diet, exercise and oral agents such as sulfonylureas, metformin and glitazone-type compounds. Many of these agents exhibit side effects and have limited efficacy. There is a need for new agents which do not possess these drawbacks. Because of the limited efficacy of each method of treatment often the oral agents are giving in combination of with each other or with insulin.
Elevated serum triglyceride levels are also commonly associated with diabetes; however, this condition is also widely seen in nondiabetic patients. The mechanism causing the presence of elevated triglyceride levels in patients, both diabetic and otherwise, is different from that underlying chronic diabetes-related complications directly treatable by inhibition of aldose reductase activity. There is, therefore, a need for treatment of elevated triglyceride levels in diabetic and/or nondiabetic patients, e.g., cardiac patients.
This invention provides pharmaceutical compositions that comprise an angiotensin converting enzyme (ACE) inhibitor in combination with compounds that interact with and inhibit aldose reductase. Thus, in a broad aspect, the invention provides pharmaceutical compositions comprising an ACE inhibitor and compounds of Formula I: 
or pharmaceutically acceptable salts thereof wherein
A is a C1-C4 alkylene group optionally substituted with C1-C2 alkyl or mono- or disubstituted with halogen, preferably fluoro or chloro;
Z is a bond, O, S, C(O)NH, or C1-C3 alkylene optionally substituted with C1-C2 alkyl;
R1 is hydrogen, alkyl having 1-6 carbon atoms, halogen, 2-, 3-, or 4-pyridyl, or phenyl, where the phenyl or pyridyl is optionally substituted with up to three groups selected from halogen, hydroxy, C1-C6 alkoxy, C1-C6 alkyl, nitro, amino, or mono- or di(C1-C6)alkylamino;
R2, R3, R4 and R5 are each independently
hydrogen, halogen, nitro, or an alkyl group of 1-6 carbon atoms (which may be substituted with one or more halogens);
OR7, SR7, S(O)R7, S(O)2(R7)2, C(O)M(R7)2, or N(R7)2, wherein each R7 is independently hydrogen, an alkyl group of 1-6 carbon atoms (which may be substituted with one or more halogens) or benzyl, where the phenyl portion is optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6--alkoxy, amino, and mono- or di(C1-C6)alkylamino; phenyl or heteroaryl such as 2-, 3- or 4-imidazolyl or 2-, 3-, or 4-pyridyl, each of which phenyl or heteroaryl is optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di(C1-C6)alkylamino;
phenoxy where the phenyl portion is optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di(C1-C6)alkylamino; or
a group of the formula 
xe2x80x83where
J is a bond, CH2, oxygen, or nitrogen; and
each r is independently 2 or 3;
R6 is hydroxy or a prodrug group;
Ra is hydrogen, C1-C6 alkyl, fluoro, or trifluoromethyl; and
Ar represents aryl or heteroaryl, each of which is optionally substituted with up to five groups.
The compounds of Formula I inhibit aldose reductase. Since aldose reductase is critical to the production of high levels of sorbitol in individuals with diabetes, inhibitors of aldose reductase are useful in preventing and/or treating various complications associated with diabetes. The compounds of the invention are therefore effective for the treatment of diabetic complications as a result of their ability to inhibit aldose reductase.
In another aspect, the invention provides methods for treating and/or preventing chronic complications associated with diabetes mellitus, including, for example, diabetic cataracts, retinopathy, keratopathy, wound healing, diabetic uveitis, diabetic cardiomyopathy, nephropathy, and neuropathy.
The compounds of Formula I also possess antihyperglycemic activity and are therefore useful for the treatment of hyperglycemia. Accordingly, an aspect of the invention is prevention and/or alleviation of complications associated with hyperglycemia with the pharmaceutical compositions of the invention.
The compounds of Formula I have been discovered to lower triglycerides. While serum triglyceride levels are often elevated in diabetic patients, they are also frequently elevated in nondiabetic patients resulting in various diseases and disorders, e.g., cardiac disease. Because of their ability to reduce serum triglyceride levels, the compositions of the present invention are useful in the treatment, i.e., prevention and/or alleviation, of elevated triglyceride levels in both diabetic and nondiabetic patients.
Thus, the compositions of the present invention may be used as antihyperlipidemic and/or antihyperglycemic agents. The compounds of Formula I may be given in combination with other glucose or lipid lowering agents as well as other agents that are given specifically to treat the complications of diabetes.
It has also been discovered that the compounds of Formula I exhibit anti-angiogenic activity in an established in vitro assay. The discovery of this biological activity for the compounds of the invention is unexpected. As a result of this biological activity, the compositions of the invention can be used to treat various diseases that exhibit aberrant vasoproliferation. According to the invention, the composition would be administered to a mammal in need of inhibition of vasoproliferation, i.e., inhibition of angiogenesis. Examples of such diseases are diabetic retinopathy, age-related macular degeneration, retinopathy of prematurity, corneal neovascularization, pterygium, and any neoplasms (cancers) which appear to be angiogenesis dependent. Administration of the compound(s) of this invention is/are not limited to a particular mode, and could be administered systemically or topically to the eye in an appropriate ophthalmic solution. The compounds of Formula I may be administered in combination therapy with other known anti-angiogenic agents.
The compounds of Formula I have also been discovered to promote the healing of wounds in mammals. In preferred aspects, these compounds are useful in promoting wound healing in diabetic mammals. Thus, these compounds may be employed in the treatment of wounds in mammals, preferably humans, more preferably in diabetic humans.
In a preferred aspect, the invention provides pharmaceutical compositions containing compounds of Formula I.
In still another aspect, the invention provides for the use of a compound or compounds of Formula I for the preparation of a pharmacetical composition for the treatment of any of the disorders or diseases (a) listed above, (b) connected with diabetic complications, hyperglycemia, or hypertriglyceridemia, or (c) where inhibition of vasoproliferation is indicated.
Prolonged administration of an ACE inhibitor at a therapeutically effective dose may be deleterious or give rise to side effects in certain patients, for example, it may lead to significant deterioration of renal function, induce hyperkalemia, neutropenia, angioneurotic oedema, rash or diarrhea or give rise to a dry cough. Administration of an ARI such as those of Formula I may also give rise to deleterious effects or side effects at the dose required to inhibit the enzyme aldose reductase sufficiently to produce a significant beneficial therapeutic effect. The present invention decreases the likelihood of problems associated with administration of indole acetic acids of Formula I or an ACE inhibitor that otherwise may result from administration of one of these agents alone. Furthermore, diabetic complications involve a complex mechanism or number of mechanisms, which initiate a cascade of biochemical alternations that in turn lead to structural changes. These may result in a diverse patient population. The present invention, therefore, provides the additional advantage that it allows tailoring of treatment to the needs of a particular patient population.
Accordingly, the present invention provides a pharmaceutical composition which comprises a compound of Formula I and an ACE inhibitor, together with a pharmaceutically acceptable carrier and/or diluent. In addition, the invention contemplates methods of treating diseases or disorders associated with elevated plasma levels of glucose, including complications associated with diabetes and hypertension and/or, congestive heart failure. These methods comprise administering an effective amount of a compound of Formula I in combination with an ACE inhibitor to a patient in need of such treatment, e.g., a patient suffering from diabetes or hypertension or a patient likely to contract either of those diseases.
As used herein, the term xe2x80x9ctreatmentxe2x80x9d includes both prevention and alleviation.
The numbering system for the compounds of Formula I is as follows: 
As noted above, the invention provides pharaceutical compositions comprising an ACE inhibitor and a substituted indole alkanoic acid useful in treating and/or preventing, for example, complications associated with or arising from elevated levels of glucose in individuals suffering from diabetes mellitus. These alkanoic acids are represented by Formula I above.
In compounds of Formula I, the aryl and heteroaryl groups represented by Ar include:
a phenyl group optionally substituted with up to 5 groups independently selected from halogen, an alkyl group of 1-6 carbon atoms (which may be substituted with one or more alogens), nitro, OR7, SR7, S(O)R7, S(o)2R7 or N(R7)2 wherein R7 is hydrogen, an alkyl group of 1-6 carbon atoms (which may be substituted with one or more halogens) or benzyl, where the phenyl portion is optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di(C1-C6)alkylamino, or the phenyl group may be condensed with benzo where the benzo is optionally substituted with one or two of halogen, cyano, nitro, trifluoromethyl, perfluoroethyl, trifluoroacetyl, or (C1-C6)alkanoyl, hydroxy, (C1-C6)alkyl, (C1-C6)alkoxy, (C1-C6)alkylthio, trifluoromethoxy, trifluoromethylthio, (C1-C6)alkylsulfinyl, (C1-C6)alkylsulfonyl;
a heterocyclic 5-membered ring having one nitrogen, oxygen or sulfur, two nitrogens one of which may be replaced by oxygen or sulfur, or three nitrogens one of which may be replaced by oxygen or sulfur, said heterocyclic 5-membered ring substituted by one or two fluoro, chloro, (C1-C6)alkyl or phenyl, or condensed with benzo, or substituted by one of pyridyl, furyl or thienyl, said phenyl or benzo optionally substituted by one of iodo, cyano, nitro, perfluoroethyl, trifluoroacetyl, or (C1-C6)alkanoyl, one or two of fluoro, chloro, bromo, hydroxy, (C1-C6) alkyl, (C1-C6) alkoxy, (C1-C6) alkylthio, trifluoromethoxy, trifluoromethylthio, (C1-C6)alkylsulfinyl, (C1-C6)alkylsulfonyl or trifluoromethyl, or two fluoro or two trifluoromethyl with one hydroxy or one (C1-C6)alkoxy, or one or, preferably, two fluoro and one trifluoromethyl, or three fluoro, said pyridyl, furyl or thienyl optionally substituted in the 3-position by fluoro, chloro, bromo, (C1-C6)alkyl or (C1-C6)alkoxy;
a heterocyclic 6-membered ring having one to three nitrogen atoms, or one or two nitrogen atoms and one oxygen or sulfur, said heterocyclic 6-membered ring substituted by one or two (C1-C6)alkyl or phenyl, or condensed with benzo, or substituted by one of pyridyl, furyl or thienyl, said phenyl or benzo optionally substituted by one of iodo or trifluoromethylthio, or one or two of fluoro, chloro, bromo, (C1-C6)alkyl, (C1-C6)alkoxy, (C1-C6)alkylthio, (C1-C6)alkylsulfinyl, (C1-C6)alkylsulfonyl, or trifluoromethyl, and said pyridyl, furyl or thienyl optionally substituted in the 3-position by fluoro, chloro, (C1-C6)alkyl or (C1-C6)alkoxy;
said benzo-condensed heterocyclic 5-membered or 6-membered rings optionally substituted in the heterocyclic 5-membered or 6-membered ring by one of fluoro, chloro, bromo, methoxy, or trifluoromethyl;
oxazole or thiazole condensed with a 6-membered aromatic group containing one or two nitrogen atoms, with thiophene or with furane, each optionally substituted by one of fluoro, chloro, bromo, trifluoromethyl, methylthio or methylsulfinyl;
imidazolopyridine or triazolopyridine optionally substituted by one of trifluoromethyl, trifluoromethylthio, bromo, or (C1-C6)alkoxy, or two of fluoro or chloro;
thienothiophene or thienofuran optionally substituted by one of fluoro, chloro or trifluoromethyl; thienotriazole optionally substituted by one of chloro or trifluoromethyl;
naphthothiazole; naphthoxazole; or thienoisothiazole.
More specific compounds of Formula I are those wherein Ar is optionally substituted benzothiazolyl, benzoxazolyl, isoquinolyl, benzothiophen-yl, benzofuran-yl or benzimidazolyl, or substituted oxadiazolyl or indolyl. Other more specific compounds of Formula I are those wherein Ra is trifluoromethyl, Z is a covalent bond or CH2, R6 is hydroxy, and each of R2-R5 are independently hydrogen, halogen, more preferably bromo or chloro, C1-C2 alkyl, phenoxy, benzyloxy, or C1-C2 alkoxy, and R1 is hydrogen or methyl.
Preferred compounds are those wherein Z is a covalent bond, R6 is hydroxy, Ar is optionally substituted benzothiazol-2-yl, benzothiazol-5-yl, benzoisothiazol-3-yl, benzoxazol-2-yl, 2-quinolyl, 2-quinoxalyl, oxazolo[4,5-b]pyridine-2-yl, benzothiophen-2-yl, benzofuran-2-yl, or thazolo[4,5-pyridine-2-y, thieno[2,3-b]pyridine2-yl, imidazo[1,5-a]pyridine-2-yl, or indol-2-yl, or substituted 1,2,4-oxadiazol-3-yl, 1,2,4-oxadiazol-5-yl, isothiazol-5-yl, isothiazol-4-yl, 1,3,4-oxadiazol-5-yl, 1,2,5-thiadiazol-3-yl, oxazol-2-yl, thiazol-2-yl, or thiazol-4-yl, R2-R5 are independently hydrogen, halogen, more preferably bromo or chloro, C1-C2 alkyl, phenoxy, benzyloxy or phenyl where each phenyl portion is optionally substituted with C1-C6 alkyl, halogen, C1-C6 alkoxy, hydroxy, amino or mono- or di (C1-C6) alkylamino Ra is hydrogen, fluro or C1-C2 alkyl, and R1 is hydrogen or methyl.
Other preferred compounds are those wherein the methylene bridge connecting the indolyl group with Ar is located alpha with respect to a nitrogen atom in Ar, e.g. wherein Ar is benzoxazol-2-yl or 1,2,4-oxadiazol-3-yl mentioned above.
Other more specific compounds of Formula I are those wherein Z is a covalent bond, R6 is hydroxy, Ra is hydrogen, Ar is optionally 4,5,6 or 7 benzo-substituted benzothiazolyl, benzoxazolyl, benzimidazolyl, benzothiophenyl, benzofuranyl, or indolyl, or Ar is 2-benzothiazolyl substituted on benzo by one trifluoroacetyl or trifluoromethylthio, or one or two of fluoro chloro, bromo, hydroxy, methyl, methoxy, trifluoromethyl, trifluoromethoxy, trifluoromethylthio, or one or, preferably, two fluoro and one trifluoromethyl, or two fluoro or two trifluoromethyl with one methoxy, or three fluoro, or by 6,7-benzo, and those wherein one of R2 and R3 is hydrogen, fluoro, chloro, bromo or methyl, and one of R4 and R5 is hydrogen, or chloro, bromo, methyl, isopropyl, methoxy, nitro or trifluoromethyl; or R3 and R4 is 5,6-difluoro, Ra is hydrogen; and those wherein Ar is optionally substituted benzothiazol-2-yl or quinoxalyl and R3 and R4 are each chloro, and R1 is hydrogen or methyl.
Further more specific compounds are those wherein Z is a covalent bond, R6 is hydroxy, Ar is optionally substituted benzothiazol-2-yl, R3 and R4 are hydrogen, and R5 is methyl; those wherein Z is a covalent bond, R6 is hydroxy, R3, R4 and RS are hydrogen, chloro, fluoro, bromo or C1-C2 alkyl, Ra is hydrogen, and Ar is optionally 4,5,6 or 7 benzosubstituted benzothiazolyl-2-trifluoromethyl, benzoxazolyl-2-trifluoromethyl, benzimidazolyl-2-trifluoromethyl, benzofuran-2-trifluoromethyl, benzofuran-3-trifluoromethyl, benzothiophen-2-trifluoromethyl, benzothiophen-3-trifluoromethyl, indolyl-2-trifluoromethyl, or indolyl-3-trifluoromethyl; and those wherein Z is CH2, R6 is hydroxy, Ar is optionally substituted benzothiazol-2-yl, benzothiazol-5-yl, benzoisothiazol-3-yl, benzoxazol-2-yl, 2-quinolyl, 2-quinoxalyl, oxazolo[4,5-b]pyridine-2-yl, or thiazolo[4,5-b]pyridine-2-yl, or substituted 1,2,4-oxadiazol3-yl, 1,2,4-oxadiazol-5-yl, isothiazol-5-yl, isothiazol4-yl, 1,3,4-oxadiazol-5-yl, 1,2,5-thiadiazol-3-yl, oxazol-2-yl, thiazol-2-yl, or thiazol-4-yl, and R3, R4 and R5 are independently hydrogen, chloro, fluoro, bromo, C1-C2 alkyl, or trifluoromethyl, and Ra is hydrogen.
Generally, R1 in the specific compounds described above is hydrogen, halogen, preferably chloro or fluoro, C1-C6 alkyl, or phenyl optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di(C1-C6)alkylamino. Preferred R1 groups are hydrogen and methyl.
Preferred compounds include those where Ar in Formula I is substituted phenyl, i.e., compounds of Formula II: 
wherein
A is a C1-C4 alkylene group optionally substituted with C1-C2 alkyl;
Z is a bond, or C1-C3 alkylene optionally substituted with C1-C2 alkyl;
Ra is hydrogen, C1-C6 alkyl, chloro, bromo, fluoro, or trifluoromethyl;
R1 is hydrogen, C1-C6 alkyl, fluoro, or phenyl optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di (C1-C6) alkylamino;
R2, R3, R4 and R5 are each independently
hydrogen, halogen, an alkyl group of 1-6 carbon atoms (which may be substituted with one or more halogens), nitro, OR7, SR7, S(O)R7, S(o)2N(R7)2, C(O)N(R7)2, or N(R7)2, wherein each R7 is independently hydrogen, an alkyl group of 1-6 carbon atoms (which may be substituted with one or more halogens) or benzyl, where the phenyl portion is optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di (C1-C6)alkylamino;
phenyl or heteroaryl such as 2-, 3- or 4-imidazolyl or 2-, 3-, or 4-pyridyl, each of which phenyl or heteroaryl is optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di(C1-C6)alkylamino;
phenoxy where the phenyl portion is optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di (C1-C6) alkylamino; or
a group of the formula 
xe2x80x83where
J is a bond, CH2, oxygen, or nitrogen; and
each r is independently 2, or 3;
R6 is hydrogen, an alkoxy group of 1-6 carbon atoms, or xe2x80x94Oxe2x88x92M+ where M+ is a cation forming a pharmaceutically acceptable salt; and
R8, R9, and R10 are independently hydrogen, fluorine, chlorine, bromine, trifluoromethyl or nitro.
Other preferred compounds of Formula I are those where Ar is a substituted benzothiazole, i.e., compounds of Formula III: 
wherein
A is a C1-C4 alkylene group optionally substituted with C1-C2 alkyl;
Z is a bond, or C1-C3 alkylene optionally substituted with C1-C2 alkyl;
Ra is hydrogen, C1-C6 alkyl, chloro, bromo, fluoro, or trifluoromethyl;
R1 is hydrogen, C1-C6 alkyl, halogen, preferably chloro or fluoro, or phenyl optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di(C1-C6) alkylamino;
R2, R3, R4 and R5 are each independently hydrogen, halogen, an alkyl group of 1-6 carbon atoms (which may be substituted with one or more halogens), nitro, OR7, SR7, S(O)R7, S(O)2N(R7)2 C(O)N(R7)2 or N(R7)2, wherein each R7 is independently hydrogen, an alkyl group of 1-6 carbon atoms (which may be substituted with one or more halogens) or benzyl, where the phenyl portion is optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di (C1-C6) alkylamino;
phenyl or heteroaryl such as 2-, 3- or 4-imidazolyl or 2-, 3-, or 4-pyridyl, each of which phenyl or heteroaryl is optionally substituted with up to three groups independently selected from halogen, C1-CE alkyl, C1-C6 alkoxy, amino, and mono- or di(C1-C6)alkylamino;
phenoxy where the phenyl portion is optionally substituted with up to three groups independently selected from halogen, C1-C6 alkyl, C1-C6 alkoxy, amino, and mono- or di(C1-C6)alkylamino; or
a group of the formula 
xe2x80x83where
J is a bond, CH2, oxygen, or nitrogen; and
each r is independently 2 or 3;
R6 is hydroxy, C1-C6 alkoxy, or xe2x80x94Oxe2x88x92M+ where M+ is a cation forming a pharmaceutically acceptable salt; and
R11, R12, R13 and R14 are independently hydrogen, halogen, nitro, hydroxy, C1-C6 alkyl, C1-C6 alkoxy, C1-C6 alkylthio, trifluoromethyl, trifluoromethoxy, C1-C6 alkylsulfinyl, or C1-C6 alkylsulfonyl.
In preferred compounds of Formula III, the R2, R3, R4 and R5 substituents, in combination, represent one of bromo, cyano or nitro, one or two of fluoro, chloro, hydroxy, (C1-C6)alkyl, (C1-C6)alkoxy, or trifluoromethyl, or two fluoro or two methyl with one hydroxy or one (C1-C6)alkoxy, or one or, preferably, two fluoro and one methyl, or three fluoro groups. Particularly preferred R2, R3, R4 and R5 substituents are, independently, fluorine, chlorine, nitro, and trifluoromethyl.
In preferred compounds of Formulas II and III, A is preferably methylene, methylene substituted with a methyl group, or ethylene.
Preferred compounds according to Formula II above include those wherein R8 is fluorine, R9 is hydrogen and R10 is bromine or those wherein R8 and R10 are hydrogens and R9 is nitro.
Preferred compounds of Formula III above are those wherein the benzothiazole moiety is substituted with nitro, one, two, or three of fluoro, one or two of chloro, or at least one trifluoromethyl group. More preferred compounds of Formula II are those where A is methylene, R1 is hydrogen or methyl, Z is a bond, and R6 is hydroxy or C1-C6 alkoxy.
Still more preferred compounds of Formula II are those wherein R11, R12 and R14 are fluorines and R13 is hydrogen. Other is more preferred compounds of Formula II are those where Ra is methyl or hydrogen, Z is methylene or, more preferably, a bond, A is CHF or C1 or C2 alkylene, preferably methylene, R1 is methyl or hydrogen, and R11, R12 and R14 are halogens or C1-C3 alkyl. Still other more preferred compounds of Formula III are those where Ra is methyl or hydrogen, Z is methylene or, more preferably, a bond, A is CHF or C1 or C2 alkylene, R1 is methyl or hydrogen, and R11, R12 and R14 are fluorines or chlorines.
Particularly preferred compounds of Formula I are those where R3 and R4 are independently hydrogen, C1-C6 alkyl, C1-C6 alkoxy, or halogen, and Ra is methyl or hydrogen, Z is a bond, A is methylene, methyl substituted methylene, or ethylene, R1is methyl or hydrogen, and R11, R12 and R14 are fluorines or chlorines.
The term xe2x80x9cprodrug groupxe2x80x9d denotes a moiety that is converted in vivo into the active compound of formula I wherein R6 is hydroxy. Such groups are generally known in the art and include ester forming groups, to form an ester prodrug, such as benzyloxy, di(C1-C6)alkylaminoethyloxy, acetoxymethyl, pivaloyloxymethyl, phthalidoyl, ethoxycarbonyloxyethyl, 5-methyl-2-oxo-1,3-dioxol-4-yl methyl, and (C1-C6)alkoxy optionally substituted by N-morpholino and amide-forming groups such as di(C1-C6)alkylamino. Preferred prodrug groups include hydroxy, and C1-C6 alkoxy. Preferred compounds include the pharmaceutically acceptable salts of the compounds of Formula I e.g., those where R6 is Oxe2x88x92M+ where M+ represents a cation. Preferred cations include sodium, potassium, and ammonium. Other cations include magnesium and calcium.
In certain situations, compounds of Formula I may contain one or more asymmetric carbon atoms, so that the compounds can exist in different stereoisomeric forms. These compounds can be, for example, racemates or optically active forms. In these situations, the single enantiomers, i.e., optically active forms, can be obtained by asymmetric synthesis or by resolution of the racemates. Resolution of the racemates can be accomplished, for example, by conventional methods such as crystallization in the presence of a resolving agent, or chromatography, using, for example a chiral HPLC column.
Representative compounds of the Formula I include the pharmaceutically acceptable acid addition salts of compounds where R6 is Oxe2x88x92M+ where M+ includes basic nitrogen atom, i.e, an alkylamino or morpholino group. In addition, if the compound or prodrug of Formula I is obtained as an acid addition salt, the free base can be obtained by basifying a solution of the acid salt. Conversely, if the product is a free base, an addition salt, particularly a pharmaceutically acceptable addition salt, may be produced by dissolving the free base in a suitable organic solvent and treating the solution with an acid, in accordance with conventional procedures for preparing acid addition salts from base compounds.
Non-toxic pharmaceutical salts include salts of acids such as hydrochloric, phosphoric, hydrobromic, sulfuric, sulfinic, formic, toluenesulfonic, methanesulfonic, nitric, benzoic, citric, tartaric, maleic, hydroiodic, alkanoic such as acetic, HOOCxe2x80x94(CH2)nxe2x80x94ACOOH where n is 0-4, and the like. Non-toxic pharmaceutical base addition salts include salts of bases such as sodium, potassium, calcium, ammonium, and the like. Those skilled in the art will recognize a wide variety of non-toxic pharmaceutically acceptable addition salts.
As used herein, the terms 2-benzothiazolyl and benzothiazol-2-yl are synonymous.
Representative groups of the formula 
include those where J is oxygen and each r is 2 (morpholinyl), J is nitrogen and each r is 2 (piperazinyl) or one r is 2 and the other 3 (homopiperazinyl), or J is CH2 and each r is 2 (piperidinyl) or one r is 2 and the other 3 (homopiperidinyl). Preferred groups of this formula are morpholinyl and piperazinyl.
The heterocyclic 5-membered ring having one to three nitrogen atoms, one of which may be replaced by oxygen or sulfur includes imidazolyl, oxazolyl, thiazolyl, pyrazolyl, oxadiazolyl, thiadiazolyl, and triazolyl.
The heterocyclic 6-membered ring having one to three nitrogen atoms, or one or two nitrogen atoms and one oxygen or sulfur includes triazinyl, pyrimidyl, pyridazinyl, oxazinyl and triazinyl.
The heterocyclic ring may be condensed with benzo so that said ring is attached at two neighboring carbon atoms to form a phenyl group. Such benzoheterocyclic ring may be attached to Z either through the heterocyclic group or through the benzo group of the benzoheterocyclic ring. Specific groups wherein said heterocyclic ring is condensed with a benzo include benzoxazolyl, quinazolin-2-yl, 2-benzimidazolyl, quinazolin-4-yl and benzothiazolyl. The oxazole or thiazole condensed with a 6-membered aromatic group containing one or two nitrogen atoms include positional isomers such as oxazolo[4,5-b]pyridine-2-yl, thiazolo[4,5-b]pyridine-2-yl, oxazolo[4,5-c]pyridine-2-yl, thiazolo[4,5-c]pyridine-2-yl, oxazolo[5,4-b]pyridine-2-yl, thiazolo[5,4-b]pyridine-2-yl, oxazolo[5,4-c]pyridine-2-yl, and thiazolo[5,4-c]pyridine-2-yl.
The following compounds of Formula I are provided to give the reader an understanding of the compounds encompassed by the invention:
3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
5-chloro-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
2-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
5-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
7-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
6-chloro-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
5-benzyloxy-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
6-fluoro-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
5-fluoro-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
6-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
3-methyl(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-2 propionic acid
3-methyl(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-3 propionic acid
3-(5-trifluoromethylbenzothiazol-2-yl)methyl-indole-N-acetic acid
5-methyl-3-(5-trifluoromethylbenzothiazol-2-yl)methyl-indole-N-acetic acid
3-(3-nitrophenyl)methyl-indole-N-acetic Acid
The above compounds, further described in the Examples and other description of the invention below, are illustrative but are not meant to limit in any way the scope of the invention.
The compounds of Formula I are administered to a patient or subject in need of treatment either alone or in combination with other compounds having similar or different biological activities. In addition, the pharamceutical compositions comprising an ACE inhibitor and a compound of Formula I may also be used in combination with other compounds. For example, the compounds and compositions of the invention may be administered in a combination therapy, i.e., either simultaneously in single or separate dosage forms or in separate dosage forms within hours or days of each other. Examples of such combination therapies include administering the compositions and compounds of Formula I with other agents used to treat hyperglycemia, hyperlipidemia, and diabetic complications.
Suitable compounds for use in combination therapy include
For Hyperglycemia:
Insulin
Metformin
Troglitazone
Pioglitazone
Rosiglitazone
Darglitazone
Sulfonylureass such as glipizide and glimepiride
Repaglinide
alpha-glucosidase inhibitors such as acarbose, miglitol
For Diabetic complications:
ACE inhibitors: Captopril, enalapril, lisinopril, omaprilat
Angiotensin II receptor antagonists (ATI-receptor) such as candesartan, losartan, irbesartan, and valsartan
MMP inhibitors
Protein kinase C inhibitors
For Antihyperlipidemia:
Statins such as Atorvastatin, simvastatin, pravastatin, fluvastatin, lovastatin, cerivastatin
Fibrates such as Fenofibrate, bezafibrate, ciprofibrate, gemfibrozil
The compositions of the invention may be administered orally, topically, parenterally, by inhalation or spray or rectally in dosage unit formulations containing conventional non-toxic pharmaceutically acceptable carriers, adjuvants and vehicles. The term parenteral as used herein includes subcutaneous injections, intravenous, intramuscular, intrasternal injection or infusion techniques. The pharmaceutical compositions may comprise an ACE inhibitor, a compound of general Formula I and a pharmaceutically acceptable carrier. One or more ACE inhibitors and compounds of general Formula I may be present in association with one or more non-toxic pharmaceutically acceptable carriers and/or diluents and/or adjuvants and if desired other active ingredients. The pharmaceutical compositions may be in a form suitable for oral use, for example, as tablets, troches, lozenges, aqueous or oily suspensions, dispersible powders or granules, emulsion, hard or soft capsules, or syrups or elixirs.
Compositions intended for oral use may be prepared according to any method known to the art for the manufacture of pharmaceutical compositions and such compositions may contain one or more agents selected from the group consisting of sweetening agents, flavoring agents, coloring agents and preserving agents in order to provide pharmaceutically elegant and palatable preparations. Tablets contain the active ingredient in admixture with non-toxic pharmaceutically Unacceptable excipients which are suitable for the manufacture of tablets. These excipients may be for example, inert diluents, such as calcium carbonate, sodium carbonate, lactose, calcium phosphate or sodium phosphate; granulating and disintegrating agents, for example, corn starch, or alginic acid; binding agents, for example starch, gelatin or acacia, and lubricating agents, for example magnesium stearate, stearic acid or talc. The tablets may be uncoated or they may be coated by known techniques to delay disintegration and absorption in the gastrointestinal tract and thereby provide a sustained action over a longer period. For example, a time delay material such as glyceryl monostearate or glyceryl distearate may be employed.
Formulations for oral use may also be presented as hard gelatin capsules wherein the active ingredient is mixed with an inert solid diluent, for example, calcium carbonate, calcium phosphate or kaolin, or as soft gelatin capsules wherein the active ingredient is mixed with water or an oil medium, for example peanut oil, liquid paraffin or olive oil.
Aqueous suspensions contain the active materials in admixture with excipients suitable for the manufacture of aqueous suspensions. Such excipients are suspending agents, for example sodium carboxymethylcellulose, methylcellulose, hydropropylmethylcellulose, sodium alginate, polyvinylpyrrolidone, gum tragacanth and gum acacia; dispersing or wetting agents may be a naturally-occurring phosphatide, for example, lecithin, or condensation products of an alkylene oxide with fatty acids, for example polyoxyethylene stearate, or condensation products of ethylene oxide with long chain aliphatic alcohols, for example heptadecaethyleneoxycetanol, or condensation products of ethylene oxide with partial esters derived from fatty acids and a hexitol such as polyoxyethylene sorbitol monooleate, or condensation products of ethylene oxide with partial esters derived from fatty acids and hexitol anhydrides, for example polyethylene sorbitan monooleate. The aqueous suspensions may also contain one or more preservatives, for example ethyl, or n-propyl p-hydroxybenzoate, one or more coloring agents, one or more flavoring agents, and one or more sweetening agents, such as sucrose or saccharin.
Oily suspensions may be formulated by suspending the active ingredients in a vegetable oil, for example arachis oil, olive oil, sesame oil or coconut oil, or in a mineral oil such as liquid paraffin. The oily suspensions may contain a thickening agent, for example beeswax, hard paraffin or cetyl alcohol. Sweetening agents such as those set forth above, and flavoring agents may be added to provide palatable oral preparations. These compositions may be preserved by the addition of an anti-oxidant such as ascorbic acid.
Dispersible powders and granules suitable for preparation of an aqueous suspension by the addition of water provide the active ingredient in admixture with a dispersing or wetting agent, suspending agent and one or more preservatives. Suitable dispersing or wetting agents and suspending agents are exemplified by those already mentioned above. Additional excipients, for example sweetening, flavoring and coloring agents, may also be present.
Pharmaceutical compositions of the invention may also be in the form of oil-in-water emulsions. The oily phase may be a vegetable oil, for example olive oil or arachis oil, or a mineral oil, for example liquid paraffin or mixtures of these. Suitable emulsifying agents may be naturally-occurring gums, for example gum acacia or gum tragacanth, naturally-occurring phosphatides, for example soy bean, lecithin, and esters or partial esters derived from fatty acids and hexitol, anhydrides, for example sorbitan monoleate, and condensation products of the said partial esters with ethylene oxide, for example polyoxyethylene sorbitan monoleate. The emulsions may also contain sweetening and flavoring agents.
Syrups and elixirs may be formulated with sweetening agents, for example glycerol, propylene glycol, sorbitol or sucrose. Such formulations may also contain a demulcent, a preservative and flavoring and coloring agents. The pharmaceutical compositions may be in the form of a sterile injectable aqueous or oleaginous suspension. This suspension may be formulated according to the known art using those suitable dispersing or wetting agents and suspending agents which have been mentioned above. The sterile injectable preparation may also be sterile injectable solution or suspension in a non-toxic parentally acceptable diluent or solvent, for example as a solution in 1,3-butanediol. Among the acceptable vehicles and solvents that may be employed are water, Ringer""s solution and isotonic sodium chloride solution. In addition, sterile, fixed oils are conventionally employed as a solvent or suspending medium. For this purpose any bland fixed oil may be employed including synthetic mono- or diglycerides. In addition, fatty acids such as oleic acid find use in the preparation of injectables.
The compositions of the invention may also be administered in the form of suppositories for rectal administration of the drug. These compositions can be prepared by mixing the drugs with a suitable non-irritating excipient which is solid at ordinary temperatures but liquid at the rectal temperature and will therefore melt in the rectum to release the drug. Such materials are cocoa butter and polyethylene glycols.
The compositions may also be administered parenterally in a sterile medium. The drugs, depending on the vehicle and concentration used, can either be suspended or dissolved in the vehicle. Advantageously, adjuvants such as local anesthetics, preservatives and buffering agents can be dissolved in the vehicle.
Combinations of an ACE Inhibitor and Compounds of Formula I
As noted above, the invention also provides pharmaceutical compositions that comprise a compound of Formula I and an ACE inhibitor, together with a pharmaceutically acceptable carrier and/or diluent.
Suitable ACE inhibitors useful in the compositions of the present invention include, for example, benazepril, benazeprilat, captopril, delapril, fentiapril, fosinopril, libenzapril, moexipril, pentopril, perindopril, pivopril, quinapril, quinaprilar, ramipril, spirapril, spiraprilat, zoefenopril, ceronapril, enalapril, indolapril, lisinopril, alacepril, omaprilat, and cilazapril, or a pharmaceutically acceptable salt thereof. A preferred ACE inhibitor includes, for example, lisinopril.
Omaprilat, (4S, 7S, 10aS)-5-Oxo-4-[3-phenyl-2(S)-sulfanylpropionamido]perhydropyrido[2,1-b][1,3]thiazepine-7-carboxylic acid, has the formula: 
Suitable compounds of Formula I for use in combination with an ACE inhibitor include
3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
5-chloro-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
2-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
5-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
7-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
6-chloro-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
5-benzyloxy-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
6-fluoro-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
5-fluoro-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
6-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
3-methyl(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-2 propionic acid
3-methyl(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-3 propionic acid
3-(5-trifluoromethylbenzothiazol-2-yl)methyl-indole-N-acetic acid
5-methyl-3-(5-trifluoromethylbenzothiazol-2-yl)methyl-indole-N-acetic acid
3-(3-nitrophenyl)methyl-indole-N-acetic Acid
Particularly preferred compounds of Formula I useful in combination with an ACE inhibitor are
3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
2-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
5-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
7-methyl-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
6-fluoro-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
5-fluoro-3-(4,5,7-trifluorobenzothiazol-2-yl)methyl-indole-N-acetic acid
Independent aspects of the present invention include a pharmaceutical composition which comprises any one of the compounds of Formula I described herein and any one of the named ACE inhibitors identified above, together with a pharmaceutically acceptable carrier and/or diluent. Accordingly, further independent aspects of the present invention include the following:
Pharmaceutically acceptable salts of the compounds of Formula I are described above. Pharmaceutically acceptable salts of the ACE inhibitors, in accordance with the present invention, are salts formed with physiologically acceptable bases and/or acids well known to those skilled in the art of pharmaceutical technique. Suitable salts with physiologically acceptable bases include, for example, alkali mental and alkaline earth metal salts, such as sodium, potassium calcium and magnesium salts, and ammonium salts and salts with suitable organic bases, such as methylamine, dimethylamine, trimethylamine, piperidine, morpholine and triethanolamine. Suitable salts with physiologically acceptable acids include, for example, salts with inorganic acids such as hydrohalides (especially hydrochlorides or hydrobromides), sulphates and phosphates, and salts with organic acids.
Compositions for oral administration are preferred.
The doses of a compound of Formula I and an ACE inhibitor which can be administered in accordance with the present invention depends on several factors, for example, the age, weight and the severity of the condition under treatment, as well as the route of administration, dosage form and regimen and the desired result, and additionally the potency of the particular compound of Formula I and ACE inhibitor employed in the composition. In addition, account should be taken of the recommended maximum daily dosages for the ACE inhibitors.
Dosage levels of each of the compounds of Fromula I and the ACE inhibitor on the order of from about 0.1 mg to about 140 mg per kilogram of body weight per day are useful in the treatment of the above-indicated conditions (about 0.5 mg to about 7 g per patient per day). The amount of active ingredient that may be combined with the carrier materials to produce a single dosage form will vary depending upon the host treated and the particular mode of administration. Dosage unit forms will generally contain between from about 1 mg to about 1000 mg of an active ingredient.
It will be understood, however, that the specific dose level for any particular patient will depend upon a variety of factors including the activity of the specific compound employed, the age, body weight, general health, sex, diet, time of administration, route of administration, and rate of excretion, drug combination and the severity of the particular disease undergoing therapy.
Thus, a unit dosage formulation such as a tablet or capsule will usually contain, for example, from 0.1 mg to 500 mg of a compound of Formula I and from 0.1 mg to 500 mg of an ACE inhibitor. Preferably a unit dose formulation will contain 0.1 mg to 100 mg of a compound of Formula I and 0.1 to 100 mg of an ACE inhibitor.
The pharmaceutical compositions of the present invention may be administered up to six times daily, conveniently 1 to 4 times daily and preferably 1 to 2 times daily, so that a dose of the compound of Formula I in the general range of 0.01 to 100 mg/kg, preferably 0.1 to 10 mg/kg, more preferably 0.1 to 5 mg/kg, is administered daily and a dose of the ACE inhibitor in the general range 0.01 to 100 mg/kg, preferably 0.01 to 20 mg/kg, more preferably 0.01 to 1 mg/kg, is administered daily.
The present invention covers the combination of (or product containing) a compound of Formula I and an ACE inhibitor for simultaneous, separate or sequential use in the treatment of diabetic complications. In one aspect of the present invention, the compound of Formula I or a pharmaceutically acceptable salt thereof and an ACE inhibitor or a pharmaceutically acceptable salt thereof are presented in admixture in one pharmaceutical dosage form. In another aspect, the present invention covers the administration of separate unit dosages of the compound of Formula I and the ACE inhibitor in order to achieve the desired therapeutic effect. Such separate unit dosages may be administered concurrently or sequentially as determined by the clinician. Preferably the compound of Formula I and the ACE inhibitor are both administered orally. The present invention also covers an agent for the treatment of diabetic complications comprising a pharmaceutically acceptable carrier and/or diluent and, as active agents, a compound of Formula I and an ACE inhibitor in quantities producing a synergistic therapeutic effect.
In another aspect of the invention there is provided a combination of pharmaceutical compositions for combination therapy of diabetic complications, the combination consisting of a pharmaceutical composition comprising a compound of Formula I and a pharmaceutical composition comprising an ACE inhibitor. Particular diabetic complications include, for example, diabetic neuropathy, diabetic nephropathy and diabetic retinopathy.
A further aspect of the present invention comprises the use of a compound of Formula I and an ACE inhibitor in the preparation of a pharmaceutical composition for use in the treatment of diabetic complications.
A further aspect of the present invention is a method for treating diabetic complications (such as diabetic neuropathy, diabetic nephropathy or diabetic retinopathy) wherein a therapeutically effective amount of a compound of Formula I in combination with an ACE inhibitor is administered systemically, such as orally or parenterally. Where the patient to be treated is normotensive, the ACE inhibitor will preferably be administered in amounts below that required to cause a reduction in blood pressure. Where the patient to be treated is hypertensive, the ACE inhibitor will preferably be used in amounts usually employed to treat hypertension. The present invention provides a method for treating diabetic complications and the amounts of the compound of Formula I and the ACE inhibitor required when administered in association with the combined therapy are lower than would normally be used, and thus, any deleterious effects or side effects are minimized.
The effect of a pharmaceutical composition containing a compound of Formula I and an ACE inhibitor of the present invention may be examined by using one or more of the published models of diabetic complications well known in the art. The pharmaceutical compositions of the present invention are particularly useful for the prevention of, reducing the development of, or reversal of, deficits in nerve function found in diabetic patients, and therefore particularly useful in the treatment of diabetic neuropathy. This may be demonstrated, for example, by measuring markers such as nerve conduction velocity, nerve amplitude, quantitative sensory testing, autonomic function testing and morphometric changes. Experimentally, studies analogous to those described in Diabetologia, 1992, Vol. 35, pages 12-18 and 1994, Vol. 37, pages 651-663 may be carried out.
A further aspect of the present invention is a method of treating or preventing the development of disease conditions associated with impaired neuronal conduction velocity in a warm-blooded animal (including a human being) requiring such treatment which comprises administering to said animal a therapeutically effective amount of a combination of a compound of Formula I and an ACE inhibitor. A further aspect of the present invention is the use of a compound of Formula I and an ACE inhibitor for the manufacture of a medicament for use in the treatment or prevention of the development of disease conditions associated with impaired neuronal conduction velocity.
A further aspect of the present invention is a method of reversing impaired neuronal conduction velocity in a warm-blooded animal (including a human being) requiring such treatment which comprises administering to said animal a therapeutically effective amount of a combination of a compound of Formula I and an ACE inhibitor. A further aspect of the present invention is the use of a compound of Formula I and an ACE inhibitor for the manufacture of a medicament for use in the reversal of impaired neuronal conduction velocity.
The compounds of Formula I may be prepared by use of known chemical reactions and procedures. General methods for synthesizing the compounds are presented below. It is understood that the nature of the substituents required for the desired target compound often determines the preferred method of synthesis. All variable groups of these methods are as described in the generic description if they are not specifically defined below. More detailed procedures for particular examples are presented below in the experimental section.
Methods of Preparation
The compounds of Formula I where Ar is benzothiazolyl can be conveniently prepared from a substituted indole moiety using general Scheme A set forth below. 
Treatment of a nitrile indole IV with a strong base such as, for example, sodium hydride, butyl lithium or sodium tert-butoxide, in a polar aprotic solvent such as acetonitrile, tetrahydrofuran or N,N-dimethylformamide followed by an treatment with an alkylating agent, e.g., ethyl or tert-butyl bromoacetate, provides the desired N-alkylated product V. Alternatiyly, phase transfer catalysis can be used in a biphasic solvent system. A general review of such alkylations can be found in Sundberg, R. J. Indoles; Chapter 11, Academic Press Inc., San Diego, Calif., 1996. Condensation with a suitable 2-amino thiophenol hydrochloride salt VI provides benzothiazole intermediate VII. These reactions are most often carried out in an alcohol solvents at elevated temperatures; however, other solvents like N,N-dimethylformamide and N-methylpyrrolidone can be used or the reactions can be carried out in the absence of solvents altogether. The scope of the reaction conditions useful for this transformation have been described previously (U.S. Pat. No. 5,700,819). General methods for the preparation of various substituted 2-amino thiophenols are also well known (J. Med. Chem. 1991, 34, 108 and Chem. Pharm. Bull. 1994, 42, 1264). In general, the best method of synthesis is determined by such factors as availability of starting materials and ease of synthesis. Deprotection of the alkanoic acid moiety VII can be carried out by methods common to those skilled in the art to result in compounds of Formula III. The method used in the deprotection depends on the type of protecting group. A description of such protecting groups and methods for deprotecting them may be found in: Protective Groups in Organic Synthesis, Second Edition, T. W. Green and P. G. M. Wuts, John Wiley and Sons, Ney York, 1991. When a methyl or ethyl ester is used, an aqueous sodium hydroxide solution in ethanol or dimethoxyethane is conveniently employed for its removal.
If not commercially available, nitrile IV can be prepared substantially as described below in Scheme B depicting the formation of 3-acetonitrile substituted indoles of Formula IV where Z is a bond. Thus, an indole moiety in a weak acid solution, for example, acetic acid in ethanol, is treated with aqueous formaldehyde and dimethyl amine in an alcohol solvent. The 3-(dimethylamino)methyl indole product can then be treated with sodium or potassium cyanide in N,N-dimethylformamide at elevated temperatures to provide the 3-acetonitrile substituted indole intermediate. Alternatively, an iminium salt like N,N-dimethylmethyleneammonium chloride can be used to prepare the 3-(dimethylamino)methyl indole intermediate. 
The 3-(dimethylamino)methyl indole intermediate can also be converted to the 3-acetonitrile substituted indole intermediate via the trimethyl ammonium salt. The salt can be prepared by treating the gramine intermediate with an alkalating agent like methyl iodide. The trimethyl ammonium salt intermediate can then be converted to the nitrile by treatment with sodium or potassium cyanide in a solvent like N,N-dimethylformamide. In general, the conversion to the acetonitrile occurs under more mild conditions when the trimethyl ammonium salt is used.
Alternatively, other compounds, such as those where Zxe2x80x94Ar represents a wide variety of substituted hetercycles, may be prepared using the general method outlined in Scheme C. Here, substituted indole intermediates where X is an activating group like hydroxyl, halogen, dialkyl amino, trialkyl ammonium or benzotriazole are coupled with Qxe2x80x94Zxe2x80x94Ar groups using methods well-established in indole chemistry. Examples of these methods where Q is Na or H and Z is sulfur, oxygen, nitrogen carbon or a bond are described in (A) Tidwell, J. H.; Peat, A. J.; Buchwald, S. L. J. Org. Chem. 1994, 59, 7164; (B) Bruneau, P.; Delvare, C.; Edwards, M. P.; McMillan, R. M. J. Med. Chem. 1991, 34, 1028; (C) Gan, T.; Cook, J. M. Tetrahedron Lett. 1997, 38, 1301; (D) Cerreto, F.; Villa, A.; Retico, A.; Scalzo, M. Eur. J. Med. Chem. 1992, 27 701; (E) Majchrzak, M. W.; Zobel, J. N.; Obradovich, D. J.; Synth. Commun. 1997, 27, 3201; (F) DeLeon, C. Y.; Ganem, B. J. Org. Chem. 1996, 61, 8730; (G) Katritzky, A. R.; Toader, D; Xie, L. J. Org. Chem. 1996, 61, 7571.
It is understood that, depending on the specific chemistry used, a protecting group, P, may be required. In general, P represents groups such as acyloxy, alkyl, sulfonyl or Axe2x80x94COOR. The use of these general methods is illustrated in Protective Groups in Organic Synthesis, Second Edition, T. W. Green and P. G. M. Wuts, John Wiley and Sons, Ney York, 1991. 
In general, the intermediate compounds wherein R2-6 is aryl or heteroaryl can be synthesized by the chemistry illustrated in reaction Scheme D below. For example, treatment of the potassium salt of an optionally substituted bromoindole with tert-butyllithium at low temperature in an ethereal solvent such as ether or tetrahydrofuran followed by the addition of an electrophile represents a general method for obtaining substituted indoles, as described by Rapoport, H. (J. Org. Chem. 1986, 51, 5106). For a discussion of a synthesis where R is acyl, see Biorg. Med. Chem. Lett. 1999, 9, 333; where R is, thiomethyl, see Heterocycles, 1992, 34, 1169; and where R is cycloalkyl, see J. Med. Chem. 1999, 42, 526.
More specifically the addition of a trialkyl borate followed by an acidic work-up provides the desired indole boronic acids (Heterocycles, 1992, 34, 1169). Indole boronic acids can be used in well established transition metal catalyzed coupling reactions like the Suzuki reaction to provide aryl and heteroaryl indoles. These reactions are most often carried out in a mixture of ethereal or alcohol solvents with aqueous base in the presence of palladium catalyst, such as Pd(OAc)2, Pd(OAc)2 w/PPh3 or Pd(PPh3)4 as described in Tetrahedron Lett. 1998, 39, 4467, J. Org. Chem. 1999, 64, 1372 and Heterocycles 1992, 34, 1395.
Alternatively, an optionally substituted bromoindole can be treated with an arylboronic acid and a palladium catalyst to provide arylindoles in large quantities (Synlett 1994, 93). A general review of Suzuki cross-couplings between boronic acids and aryl halides can be found in Miyaura, N; Suzuki, A. Chem. Rev. 1995, 95, 2457. 
For example, treatment of the advanced intermediate indole X with an aryl or heteroaryl boronic acid using Pd-mediated coupling conditions provides the desired aryl and heteroaryl indole product XI as shown in scheme (E). In general the utility of this method is determined by the ease of synthesis of advanced intermediates of type X and the commercial availability of aryl and heteroaryl boronic acids. 
In addition, certain organometallic reactions eliminate the need for de novo construction of the indole nucleus. For example, the Stille reaction serves as a general method for the synthesis of regiocontrolled substitution of indole intermediates as described by Farina, V.; Krishnamurthy, V; Scott, W., Organic Reactions, 1998, 50, 1-652. As indicated in the scheme below, the indole may serve as the organotin species or the aryl halide. The stannylindole (XII), where P is a suitable protecting group such as [2-(trimethyl)ethoxy]methyl (SEM) or an alkyl substituent, is treated with a variety of partners (i.e., vinyl/allylic halides, vinyl triflates, aryl/heteroaryl halides and acyl halides) in the presence of a Pd(O)Ln catalyst to provide the desired indoles (XII) (Synnlett 1993, 771, Helv. Chim. Acta 1993, 76, 2356 and J. Org. Chem. 1994, 59, 4250). Conversely, a haloindole (XIV) is treated with a variety of tin reagents under Stille conditions to provide the desired substituted indoles (XV) as described in Heterocycles 1988, 27, 1585 and Synth. Comm 1992, 22, 1627). 
A general procedure for the synthesis of intermediate compounds using amines of the formula NRxRX2 (NR1R2 in the scheme below) is given in scheme F below. In Scheme F, Rx and Rx2 are the same or different and represent hydrogen, C1-C6 alkyl, or Rx and Rx2 together represent a group of the formula: 
where J and each r is as defined above for formula I.
As shown in Scheme F, nucleophilic substitution of X (X is halogen, preferably fluorine) in an aromatic system is a method often used to substitute aromatic rings with amine and ether functionalities. Both 4- and 5-fluoro-2-nitrotoluene are sufficiently activated to undergo substitution with amines in the presence of K2CO3 in a polar aprotic solvent such as, for example, DMSO as described in J. Med. Chem. 1993, 36, 2716. The Leimgruber-Batcho two-step method is a general process for the construction of the indole ring system from the appropriate o-nitrotoluene. This reaction involves the condensation of an o-nitrotoluene with N,N-dimethylformamide dimethyl acetal followed by a reductive cyclization under suitable conditions such as hydrogen over a palladium catalyst or Zn/HOAc as described in Sundberg, R. J. Indoles; Chapter 2, Academic Press Inc., San Diego, Calif., 1996. A representative description of the process can also be found in Organic Synthesis, 1984, 63, 214. 
A general procedure for the synthesis of intermediate compounds wherein R is an aromatic, heteroaromatic or alkyl group is indicated in Scheme G below. As previously described, nucleophilic substitution of halogen, preferably fluorine, in an aromatic system is a method often used to substitute aromatic rings with amine and ether functionalities. Both 4- and 5-fluoro-2-nitrotoluene are sufficiently activated enough to undergo substitution with alcohols or phenols in the presence of K2CO3 in a polar aprotic solvent such as DMSO. A similar system using KOH and phenol is described in J. Med. Chem. 1994, 37, 1955. Alternatively, solid-liquid phase transfer catalysis (PTC) methods have been used to prepare intermediate ethers of this type as described in Synth. Comm. 1990, 20, 2855. The appropriately substituted o-nitrotoluene can then be converted to the appropriate indole by the Leimgruber-Batcho method previously desribed. 
The preparation of intermediate alkoxy indole compounds wherein R is C1-C6 alkyl is outlined in Scheme H below. Commercially available nitrophenols can be alkylated under mild conditions with a base such as, for example, K2CO3 or Cs2CO3, in a polar aprotic solvent, e.g. CH3CN, with a variety of suitable alkyl halides. See Synth. Comm. 1995, 25, 1367. The alkoxy o-nitrotoluene can then be converted to the desired indole as described above. 
Alternatively, some examples of Formula I where Z is a bond and Ar is a substituted heterocycle such as a thiazole; or Z is amide and Ar is a substituted phenyl can be conveniently prepared from an indole 3-acetic acid derivative as illustrated in Scheme I. Using this method, the carboxylic acid moiety is activated and coupled with an aryl amine. Some examples of activating methods well-known to those skilled in the art include formation of acid chloride, mixed anhydrides and coupling reagents such as 1,3-dicyclohexylcarbodiinide (DCC). A review of such method can be found in Bodanszky, M. Principles of Peptide Synthesis; Springer-Verlag: New York, 1984. For the examples where Z is a bond and Ar is a substituted benzothiazole or benzoxazole, the intermediate amide or thioamide can be cyclized into the aromatic ring. Examples of these types of hetercycle forming reactions are described in Mylar, B. L. et al. J. Med. Chem. 1991, 341 108. In addition, the carboxylic acid can be converted to a chloro- or bromomethyl ketone and condensed with nucleophiles like thioamides or 2-aminothiophenols to produce thiazole or benzothiazine derivatives. Examples of methods to prepare the chloro- and bromomethyl ketones are illustrated in Rotella, D. P.; Tetrahedron Lett. 1995, 36, 5453 and Albeck, A.; Persky, R.; Tetrahedron 1994, 50, 6333. Depending on the reaction conditions in a given synthetic sequence a protecting group may be required. It is also understood that the specific order of steps used in the synthesis depends on the particular example being prepared. P may represent H, Axe2x80x94COOH, Axe2x80x94COO-lower alkyl or a simple protecting group that can be removed at a late stage of the synthesis. When such a protecting group is used, the Axe2x80x94CO2R6 group can be introduced near the end of the synthesis after the Zxe2x80x94Ar group has been assembled. Method of introducing the Zxe2x80x94Ar group are similar to those already described. 
Another strategy involves the synthesis of substituted indoles via an intramolecular cyclization of an aniline nitrogen onto a substituted alkyne as shown in Scheme J. Typical approaches utilize commercially available o-iodoaniline derivatives. When these intermediates are unavailable, the regioselective ortho iodination of aromatic amines is used to generate the required intermediate (J. Org. Chem. 1996, 61, 5804). For example, Iodophenyl intermediates are treated with trimethylsilylacetylene in the presence of a Pd catalyst and a Cu(I) source, such as cupric iodide, to produce o-alkynylanilines. See Heterocycles, 1996, 43, 2471 and J. Org. Chem. 1997, 62, 6507. Further elaboration of the o-alkynylaniline to the desired indole can be done by a copper-mediated cyclization or a base-induced amine ring closure onto the alkyne functionality (J. Med. Chem. 1996, 39, 892). Alternative modifications have been made in the acetylenic derivatives to generate more elaborate indole structures as described in J. Am. Chem. Soc. 1991, 113, 6689, Tetrahedron Lett. 1993, 24, 2823 and Tetrahedron Lett. 1993, 34, 6471. 
Those having skill in the art will recognize that the starting materials may be varied and additional steps employed to produce compounds encompassed by the present invention, as demonstrated by the following examples. In some cases, protection of certain reactive functionalities may be necessary to achieve some of the above transformations. In general, the need for such protecting groups will be apparent to those skilled in the art of organic synthesis as well as the conditions necessary to attach and remove such groups.
The disclosures in this application of all articles and references, including patents, are incorporated herein by reference.
The preparation of the compounds of the present invention is illustrated further by the following examples, which are not to be construed as limiting the invention in scope or spirit to the specific procedures and compounds described in them.